Effect of androgens combined with hormone therapy on quality of life in post-menopausal women with sexual dysfunction

Aim. To evaluate with validated instruments changes in quality of life and sexuality in women receiving hormonal replacement therapy (AHT).

Design. Randomised, double-blind, double-dummy study with two parallel treatment arms.

Patients and methods. Forty-seven healthy post-menopausal women, aged 45–64 years, were evaluated using the Female Sexual Function Index (FSFI) and the menopause-specific quality of life questionnaire (MENQOL). Of them, 40 diagnosed with sexual dysfunction were randomised (1:1) to receive daily 0.625 mg of conjugated estrogens plus 1.25 mg of methyl-testosterone and 100 mg of micronised progesterone or placebo. After 3 months follow-up, FSFI and MENQOL questionnaires were administered for a second time.

Results. Quality of life was unchanged in the placebo group whereas AHT significantly improved scores of vasomotor, psychological, physical and sexual symptoms. As expected, FSFI was not modified in the placebo group while in AHT group the FSFI score improved significantly. In addition, at the end of the study, 68.7% of subjects of the AHT group did not fit did not fit the criteria for sexual dysfunction as per the FSFI (p < 0.0001).

Conclusions. Adding methyl-testosterone to hormone therapy improves quality of life and sexuality in post-menopausal women with sexual dysfunction.     

Effects of estrogen and estrogen–progestogen therapy on homocysteine levels and their correlation with carotid vascular resistance

Objective. To evaluate the correlation between homocysteine levels and carotid vascular resistance in menopausal women submitted to estrogen and estrogen–progestogen therapy.

Methods. Eighty-six women with a mean age of 52 years were enrolled in a prospective, randomized, double-blind, 6-month study. Patients were allocated to use one of three oral therapies: placebo (n = 26), micronized estradiol 2 mg/day (n = 30) or micronized estradiol 2 mg/day plus norethisterone acetate 1 mg/day (n = 30). Evaluation of homocysteine levels and Doppler sonography of the common carotid artery, used to calculate pulsatility index (PI), were carried out prior to initiating therapy and at the end of the study. The correlation between these two parameters was evaluated using Pearson's coefficient of correlation.

Results. There was a significant reduction in homocysteine levels in the groups treated with estrogen alone or estrogen combined with norethisterone. PI was significantly lower only in users of estrogen alone; however, no significant correlation was found between homocysteine measurements and PI.

Conclusion. No significant correlation was found between homocysteine levels and carotid vascular resistance following hormone therapy.     

The influence of hormonal replacement and growth hormone treatment on the lipids in Turner syndrome

Aim: Women with Turner syndrome (TS) have a risk of developing cardiovascular diseases. We assessed the lipid and carbohydrate metabolism in TS-women in the context of current hormone replacement therapy (HRT) and growth hormone (GH) treatment during childhood.

Methods: The information were collected from medical documentation and anamnesis of 165 TS-women (24.9?±?7.7?yr) between 1995 and 2011. The patients underwent a pituitary-gonadal axis assessment together with measurements of total cholesterol (TC), high- (HDL) and low- (LDL) density lipoproteins, triglycerides (TG), and glucose levels.

Results: Only 58% of women were using HRT. No differences were found in the levels of the lipid components and glucose in women who were undergoing HRT compared to those without it. Compared to TS-women without (n = 113), prior GH treatment in 34 TS-women positively influenced the lipid parameters: TC 5.0?±?1.1 versus 4.6?±?0.9?mmol/l (p?=?0.03), HDL 1.5?±?0.5 versus 1.4?±?0.4?mmol/l (p?>?0.05), LDL 3.3?±?0.9 versus 2.9?±?0.7?mmol/l (p?=?0.03), and TG 1.1?±?0.6 versus 0.8?±?0.3?g/l (p?=?0.009), respectively.

Conclusions: (1) HRT does not affect lipid metabolism in TS-women. (2) The use of GH in TS-children favorably influences their lipid profile in adulthood.     

Estrone – a partial estradiol antagonist in the normal breast

Abstract

Oral hormone replacement therapy (HRT) based on estradiol-17β (E2) greatly increases circulating estrone (E1) levels. E1 is an estrogen receptor agonist but may also be a partial E2 antagonist. We investigated the effects of circulating E1 on the association between circulating E2 and the increase in mammographic density (?MD) in 46 healthy post-menopausal women treated with E2 2?mg and norethisterone acetate 1?mg daily. MD and serum E1 and E2 were measured before and after 6 months of treatment. At high E1 levels, ?MD showed significant positive correlations leading to increase (?-values) in both E1 and E2. Lowering the upper serum E1 limit strengthened the correlations to ?E2 while the significant correlations to ?E1 disappeared. E1 at high concentrations may act as a partial E2 antagonist also in the normal breast in vivo and disturb relationships between circulating E2 and biological estrogen effects. When investigating the relations between circulating steroids and their effects, structurally related compounds, which may act as partial antagonists, have to be considered, at least when they are present in higher concentrations.     

Effect of Trifolium pratense-derived isoflavones on the lipid profile of postmenopausal women with increased body mass index

Background. Since current clinical evidence indicates that conventional estrogen hormone therapy (HT) increases cardiovascular risk, alternatives to estrogens are growing in popularity, especially among high-risk populations.

Objective. To determine the effect of Trifolium pratense-derived isoflavone supplementation on the lipid profile of postmenopausal women with increased body mass index (BMI).

Methods. Sixty postmenopausal women aged > 40 years, HT non-users, were randomly assigned to one of two groups: either two capsules of T. pratense (80 mg red clover isoflavones) daily for a 90-day period or placebo of equal design. After a 7-day washout period, medication was crossed-over for another 90 days. Total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C) and lipoprotein A (LpA) levels were assessed at baseline, 90 and 180 days. Women were divided into two groups: those with increased BMI (≥25 kg/m²) and those with BMI < 25 kg/m².

Results. Fifty-three women (88.3%) completed the trial. T. pratense isoflavone supplementation had a positive effect on the lipid profile of women with increased BMI, evidenced by a significant decrease in TC, LDL-C and LpA levels.

Conclusions. Isoflavones derived from T. pratense are an attractive alternative therapeutic option for high-risk populations such as postmenopausal women with increased BMI and abnormal lipid profile.     

Clinical study comparing the effects of sequential hormone replacement therapy with oestradiol/dydrogesterone and conjugated equine oestrogen/norgestrel on lipids and symptoms

A clinical study comparing the effects of sequential hormone replacement therapy with oestradiol/dydrogesterone and conjugated equine oestrogen/norgestrel on lipids and symptoms. Objective: The objective of the study was to compare the effects of sequential 17β-oestradiol/dydrogesterone and conjugated equine oestrogens (CEE)/norgestrel on lipid parameters, climacteric symptoms, bleeding patterns and tolerability. Study design: This double-blind study was conducted in 193 peri- and post-menopausal women randomised to receive six, 28-day cycles of oral sequential oestradiol 1 mg/dydrogesterone 10 mg or CEE 0.625 mg/norgestrel 0.15 mg. The change from baseline in serum lipids and hot flushes was analysed using a two-way analysis of variance. Results: After 24 weeks there was a statistically significant increase in high-density lipoprotein (HDL) cholesterol in the oestradiol/dydrogesterone group and a significant reduction in the CEE/norgestrel group. The difference between the groups was significant (P=0.001). The number of hot flushes was reduced by 86% in both groups; this improvement was supported by the Greene Climacteric Symptom Scale score, the patients’ opinion and quality of life assessments. The percentage of women experiencing cyclic bleeding was greater with CEE/norgestrel, as was the mean duration and severity of bleeding. Both treatments were well tolerated. Conclusion: Oestradiol/dydrogesterone and CEE/norgestrel were equally effective in treating climacteric symptoms, but oestradiol/dydrogesterone showed some advantages in terms of lipid profile and incidence of bleeding. Condensation : Sequential oestradiol/dydrogesterone and conjugated equine oestrogen/norgestrel are equally effective in treating climacteric symptoms, but oestradiol/dydrogesterone shows advantages in terms of lipid profile and bleeding.     

An open-label study of subdermal implants of estradiol-only versus subdermal implants of estradiol plus nomegestrol acetate: effects on symptom control,lipid profile and tolerability

Objective.?To compare the effects of continuous 17-β estradiol-only silastic implants with those of continuous 17-β estradiol plus continuous nomegestrol acetate silastic implants on symptom control, lipid profile and tolerability in postmenopausal women.

Methods.?This was an open-label, parallel-group study. Women with and without uterus and no contraindications to hormone therapy (HT) in this study, we consider as HT the replacement of Estrogens-only and Estrogens + Progestogens Therapy, were enrolled. Each subject was assigned to receive four 17-β estradiol-only silastic implants (women without uterus), or four 17-β estradiol plus one nomegestrol acetate silastic implant (women with intact uterus), for 1 year.

Results.?A total of 40 subjects were enrolled and received, the silastic implants of which 40 (100.0%) subjects completed the study (n = 20, estradiol only; n = 20, estradiol plus nomegestrol acetate). The incidence of postmenopausal symptoms decreased significantly. No significant decreases in total cholesterol (1.3%), low-density lipoprotein cholesterol (1.1%), triglycerides (1.2%) and fasting glucose ((1.3%) serum levels were observed in both groups, whereas high-density lipoprotein (HDL) cholesterol increased significantly (2.8%), during the study in both groups. The incidences of adverse events were similar in both treatment groups.

Conclusions.?Women treated with 17-β estradiol-only silastic implants or 17-β estradiol plus nomegestrol acetate silastic implants showed significant improvement of postmenopausal symptoms, including urogenital and sexual health symptoms and a significant increase in HDL cholesterol and no significant differences in other lipid profiles and tolerability.     

Increased leukocyte ABCA1 gene expression in post-menopausal women on hormone replacement therapy

Objective.?The ATP binding cassette A1 (ABCA1) is a key participant in the reverse cholesterol process whereby mediates cholesterol efflux directly to HDL particles. The aim of this study was to investigate whether long-term treatment with conventional hormone replacement therapy (HRT) in post-menopausal women could affect their leukocytes ABCA1 expression. Changes in various serum lipids and lipoprotein fractions were also investigated.

Material and Methods.?A total of 60 non-obese normolipidaemic post-menopausal women treated with oral oestrogen together with progestin therapy for 3 months were selected. Leukocytes ABCA1 gene expression and serum lipid and lipoprotein concentrations were measured at the start and end of the HRT.

Results.?HRT led to significant increases in HDL cholesterol (P?=?0.001) and apoA-I (P?=?0.046) and significant decrease in apoB (P?=?0.049) and LDL cholesterol (P?=?0.022) when compared with the baseline levels. Analysis of leukocytes ABCA1 mRNA showed a significant increase in ABCA1 gene expression after HRT (P?=?0.001). There was also a significant inverse association (r?=??0.28, P?=?0.03) between ABCA1 gene expression and log TG/HDL cholesterol changes related to HRT.

Conclusion.?The beneficial cardiovascular effects of HRT could be explained, at least in part, by increasing the ABCA1 gene expression.     

Gabapentin vs. low-dose transdermal estradiol for treating post-menopausal women with moderate to very severe hot flushes

Background.?Gabapentin (GPT), a widely used drug in neurology, has been proposed as a non-hormonal option for the management of hot flushes in menopausal women with contraindications for estrogen therapy.

Objective.?To compare GPT versus low-dose transdermal estradiol (E₂) for treating post-menopausal women with moderate to very severe hot flushes.

Methods.?A total of 45 post-menopausal women with moderate to very severe hot flushes were prospectively and single-blinded randomised to receive oral GPT 600?mg/night or transdermal 25 μg/day E₂ per week. Hot flush intensity and frequency were assessed with the Menopause Rating Scale and a numeric scale respectively at baseline and at 1, 4 and 8 weeks. Side effects were also assessed.

Results.?Hot flush intensity and frequency significantly decreased for both groups at 1, 4 and 8 weeks of treatment as compared to baseline; however, this decrease was statistically more evident for the E₂ group. Although the percentage of hot flush intensity and frequency reduction at the end of the treatment was higher for E2, this was not statistically significant (68.2% vs. 60.6% for intensity and 70.1% vs. 58.9% for frequency, respectively, p?>?0.05, NS). Encountered side effects included: drowsiness, dizziness, fatigue (GPT group) and mastodynia, vaginal spotting and a local allergic reaction (E₂ group). Compliance to treatment was 95.6% (GPT group) as compared to 90.9% for the E₂ group.

Conclusion.?Despite statistical significant differences, from a clinical point of view oral GPT 600?mg was as effective as low-dose transdermal E₂ in controlling moderate to severe hot flushes in post-menopausal women, and should be recommended as an alternative option in those with contraindications to estrogen therapy. More research is warranted in this regard.     

Effects of intranasal 17β-estradiol and raloxifene on lipid profile and fibrinogen in hypercholesterolemic postmenopausal women: A randomized,placebo-controlled clinical trial

Aim.?To compare the effects of 17β-estradiol given intranasally (intranasal E₂) and raloxifene on serum lipid profile and fibrinogen in hypercholesterolemic postmenopausal women.

Methods.?The study population consisted of 46 women after menopause. The placebo group (n = 11) was given calcium, while the intervention groups were given intranasal E₂ (Aerodiol®; Servier, Chambray-les-Tours, France) (n = 16) or raloxifene (Evista®; Lilly SA, Madrid, Spain) (n = 19). Blood lipids and fibrinogen were compared between groups at baseline and after 3 months of treatment.

Results.?The group receiving intranasal E₂ showed a significant decrease in triglyceride levels (p<0.05) and a marked increase in high-density lipoprotein cholesterol levels (p<0.05). No changes in lipid profile were observed in the raloxifene and placebo groups. Raloxifene caused a significant decrease in fibrinogen levels (p<0.05).

Conclusion.?Intranasal E₂ exerts significant effects on lipid profile in hypercholesterolemic postmenopausal women. Raloxifene has a greater impact on fibrinogen than intranasal E₂ application.     

Assessment of mammographic density in postmenopausal women during long term hormone replacement therapy

Abstract

Objective: To assess long-term effects of different hormone replacement therapy (HRT) regimens on mammographic density.

Methods: One hundred sixty-five postmenopausal women were treated with the same HRT during 5 years: 38 received transdermal estradiol, 78 cyclic combined therapy and 49 continuous combined therapy. Mammograms were obtained at baseline, at 1-year and 5-year treatment. Breast density changes were categorized as slight focal increased density, considerable focal increased density, slight diffuse increased density and considerable diffuse increased density.

Results: Mammographic density increased in 7.9% of women receiving estrogen alone versus 25.2% of women receiving combined therapy (p?<?0.022) during 1 year, and in 7.9% of women versus 28.3% of women (p?<?0.009) after 5 years of therapy, respectively. There were significant statistical differences in women treated with estrogen alone versus those treated with combined HRT after 1 and 5 years. After 5 years of HRT, breast density increased 21.8% in women receiving cyclic combined therapy versus 38.8% in those under continuous combined therapy (p?<?0.039).

Conclusion: An increase in breast density is significantly more frequent in women receiving combined estrogen-progestin therapy than in women receiving estrogen alone. There are differences between cyclic and continuous combined therapy at 5 years of treatment.     

Potential health benefits of continuous LNG-IUS combined with parenteral ERT for seamless menopausal transition and beyond – a commentary based on clinical experience

Abstract

Objective: To comment on the acceptability and potential health benefits of the continuous use of the levonorgestrel-releasing intrauterine system (LNG-IUS), combined with estrogen substitution, for seamless transition through the menopause, in women with climacteric symptoms.

Design and method: Evaluation of the recent hormone replacement therapy literature and the acceptability of the combined parenteral estrogen and intrauterine LNG-IUS regimen in a group of approximately 100 women, above 48 years of age, using LNG-IUS for contraception, who developed climacteric symptoms requiring estrogen substitution. Main outcome measures: acceptability and continued use of the method for the treatment of climacteric symptoms and for prevention.

Results: The combination of intrauterine progestogen delivery to suppress the endometrium, in combination with systemic estrogen, is highly acceptable resulting in a high continuation of use due to the absence of side effects and erratic bleeding in the large majority of women.

Conclusion: The study suggests that parenteral estrogen replacement therapy combined with intrauterine progestogen delivery for endometrial suppression in the perimenopause is highly practical and beneficial, providing enhanced quality of life. There are strong arguments to categorize the regimen as probably the most effective, safest and best accepted route resulting in high patient compliance as well as potentially providing maximal benefits for peri- and postmenopausal women.     

Raloxifene modifies the insulin sensitivity and lipid profile of postmenopausal insulin resistant women

Abstract

Objective: To investigate the effects of raloxifene on the insulin sensitivity and lipid profile in insulin-sensitive and insulin-resistant postmenopausal women.

Study design: This placebo-controlled, double-blind, randomized study involved 64 postmenopausal women aged between 45 and 55 years. All subjects were screened with the insulin resistance homeostasis model assessment (IR-HOMA) and those patients in the lowest quartile (n?=?16) were assigned as insulin sensitive and those in the highest quartile as insulin resistant (n?=?16). Patients in both groups received either raloxifene hydrochloride (60?mg/day) or a placebo for a period of 12 weeks. Insulin sensitivity, the serum lipid profile and anthropometric measurements were established before and after therapy.

Results: Women with the highest IR-HOMA scores were associated with a significantly higher weight, body mass index, waist and waist-to-hip ratio (p?<?0.05). Raloxifene significantly reduced the IR-HOMA scores from 5.76?±?2.91 to 1.93?±?0.96 (p?=?0.02) and modified the lipid profile in insulin-resistant patients when compared with the placebo group and those patients receiving raloxifene in the insulin-sensitive group.

Conclusion: Raloxifene reduced insulin resistance and modified the lipid profile in insulin-resistant postmenopausal women.     

Postmenopausal hormone replacement and obesity

Objective: To compare the association of postmenopausal hormone replacement therapy and lipid and lipoprotein levels in obese and nonobese women.Methods: We studied 4,851 postmenopausal women participating in a population-based observational study. Using cross-sectional data, women were classified into four groups according to their hormone use: current users of estrogen only, current users of estrogen and progestin, never users of hormone replacement therapy, and former users of hormone replacement therapy. Body mass index was categorized as: normal (BMI < 27.3 kg/m²), overweight (27.3 kg/m² ≤ BMI ≤ 32.3 kg/m²), and obese (BMI > 32.3 kg/m²).Results: Hormone use was associated with lower total cholesterol and low-density lipoprotein levels and higher triglyceride levels among all categories of body mass index. However, there was an interaction between hormone use and body mass index for the outcome variable high-density lipoprotein. Among users of estrogen and progestin, high-density lipoprotein levels decreased as body mass index increased. Obese users of combination therapy had a mean high-density lipoprotein level similar to that in obese never users and obese former users of hormone replacement therapy.Conclusion: Our results suggest that, in general, hormone replacement therapy is associated with a favorable lipid profile regardless of body mass index. However, among obese women on combination estrogen and progestin therapy, hormone use was not associated with higher high-density lipoprotein concentrations compared to nonusers. This observation needs further study.     

Clinical evaluation of near-continuous oral micronized progesterone therapy in estrogenized postmenopausal women

In an open non-comparative prospective trial of 12 months’ duration, we investigated the role of a novel hormone replacement therapy regimen in 40 postmenopausal women who sought hormone replacement therapy. The regimen consisted of continuous administration of 0.625 mg of conjugated equine estrogen coupled with a fixed low-dose of micronized oral progesterone administered for 23 days every calendar month.

The regimen was well tolerated, producing no major side-effects and was effective in relieving menopausal symptoms. The study showed that 40% of the women experienced side-effects and 20% withdrew from the study. Half of the 20% of the women who dropped out did so for reasons not related to treatment. All symptomatic women experienced improvement after the 1st month, and virtually all were asymptomatic by the 3rd month of treatment, persisting until the end of the trial with the average number of hot flushes per day declining from the pretreatment levels by 96%. Amenorrhea was observed in 41% of patients, amenorrhea and minimal vaginal bleeding in 78% but acyclic bleeding was present in 28%) of those in whom bleeding was re-established. Endometrial atrophy was induced in the majority of patients and no atypical endometrial hyperplasia was encountered. No significant changes were observed in blood glucose or liver enzymes. The mean percentage changes from baseline for serum cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoproteins (LDL) and LDL/HDL ratio were –6%, +32% (p< 0.001), -16% (p<0.05), +15% (p < 0.05) and-23% (p < 0.05), respectively.

The regimen was clinically effective and its apparent lack of major side-effects, the protective effect on the endometrium, the added advantage of minimal vaginal bleeding and the beneficial effect on lipid/lipoprotein levels, offer an attractive therapy and improved compliance with postmenopausal hormone replacement therapy.     

Cardiovascular risk assessment with oxidised LDL measurement in postmenopausal women receiving intranasal estrogen replacement therapy

Objective.?To investigate the effect of intranasal estrogen replacement therapy administered to postmenopausal women alone or in combination with progesterone on markers of cardiovascular risk.

Methods.?The study was conducted with 44 voluntary postmenopausal women. In group I (n?=?15), the patients were treated with only intranasal estradiol (300?μg/day estradiol hemihydrate). In group II (n?=?11), the patients received cyclic progesterone (200 mg/day micronized progesterone) for 12 days in each cycle in addition to continuous intranasal estradiol. Group III (n?=?18) was the controls. Serum lipid profiles, oxidised low-density lipoprotein (LDL) and other markers of cardiovascular risk were assessed at baseline and at the 3rd month of the treatment.

Results.?Lipid profile, LDL apolipoprotein B, lipoprotein a, homocysteine, oxidised LDL values and oxidised LDL/LDL cholesterol ratio were not observed to change after 3 months compared to baseline values within each group (p?>?0.016). In comparison to changes between the groups after the treatment, only oxidised LDL levels and oxidised LDL/LDL cholesterol ratios of group II were increased compared to control group (p?<?0.05).

Conclusions.?Intranasal estradiol alone did not appear to have an effect on markers of cardiovascular risk in healthy postmenopausal women. However, the addition of cyclic oral micronized progesterone to intranasal estradiol influenced the markers of cardiovascular risk negatively in comparison to non-users in healthy postmenopausal women.     

Tibolone versus four estrogen replacement therapy protocols and plasma lipid levels in postmenopausal women.

OBJECTIVES: To compare tibolone therapy with four different estrogen replacement therapy protocols, with regard to the effects on plasma lipid profiles. METHODS: The plasma lipid levels of 178 postmenopausal women in five different therapy groups were compared with each other as well as their baseline levels with 6-month intervals during 2-year follow-up. Student's t-test, paired t-test and Pearson correlation analysis were utilized for statistical analysis. RESULTS: HDL cholesterol levels increased significantly from baseline in groups using oral estrogen (P<0.05) but a slight non-significant decrease was seen in tibolone therapy (P>0.05). LDL cholesterol levels significantly decreased at the end of the second year in oral estrogen and tibolone users (P<0.05). Triglyceride levels increased non-significantly with estrogen therapy (P>0.05), whilst decreased significantly in the tibolone group (P<0.05). CONCLUSION: Tibolone may be a good alternative to estrogen replacement therapy in postmenopausal women, as it has beneficial effects on LDL cholesterol and triglyceride levels, which play important role in atherosclerosis.     

Transient psychosis in women on clomiphene,bromocriptine, domperidone and related endocrine drugs

Abstract

Background: There have been reports of transient psychosis in women medicated for gynecologic conditions.

Objective: The aim of this paper was to explore this literature.

Method: The PubMed and Google Scholar databases were searched for relevant case reports

Results: The following reports were found: psychosis induced by gonadotropin-releasing hormone in the treatment of endometriosis, by clomiphene treatment for infertility, by bromocriptine treatment for milk suppression and by the withdrawal of domperidone prescribed as a galactologue as well as by the withdrawal of estrogen replacement therapy.

Conclusion: In susceptible women, psychotic symptoms can result from treatments that reduce estrogen levels, such as leuprolide acetate or clomiphene, or treatments that increase dopamine levels (bromocriptine). Psychosis can also be caused indirectly when estrogen treatment is discontinued or dopamine antagonism (e.g. domperidone) withdrawn. Estrogen-reducing and dopamine-increasing treatments used in gynecology need to be carefully monitored.     

The effect of ethinyl estradiol–cyproterone acetate treatment on homocysteine levels in women with polycystic ovary syndrome

Objective Women with polycystic ovary syndrome (PCOS) have multiple risk factors for cardiovascular disease. The cardiovascular risk marker homocysteine (Hcy) is elevated in women with PCOS. This prospective study investigated the effect of oral contraceptives containing ethinyl estradiol–cyproterone acetate (EE–CA) on serum Hcy levels in women with PCOS. Study design A total of 30 women with PCOS were enrolled in this prospective study. The diagnosis of PCOS was made according to the criteria of the Rotterdam PCOS consensus workshop group. All women took oral contraceptives containing EE/CA (35 μg/2 mg) for 3 months. Serum samples for Hcy, lipid profile and hormones were obtained during the early follicular phase (days 3–5) of the spontaneous or progestin-induced bleeding at baseline, and after the third treatment cycle. Results Three months of EE–CA therapy significantly decreased the Hcy levels from 55.97 ± 16.04 to 54.03 ± 16.15 (P = 0.01). A significant correlation was observed between the Hcy and total and free testosterone levels (r = 0.44, P = 0.015 and r = 0.46, P = 0.001 respectively). Conclusions Although the decrease in Hcy levels with EE–CA therapy was statistically significant, further studies are necessary to determine the clinical benefit of this treatment.     

Effect of oestrogen replacement therapy on serum lipid profile

BACKGROUND: Oestrogen deficiency in postmenopausal women alters the lipid metabolism unfavourably. AIM: To evaluate the effects of oral and transdermal oestrogen replacement therapy (ORT) on serum lipid profile. METHODS: Ninety hysterectomised and oophorectomised women were randomised into three equal groups (no hormones; oral conjugated equine oestrogen, 0.625 mg/day; transdermal oestradiol patches, 50 microg/day). Serum concentrations of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides were determined at the baseline and after 3 and 6 months of therapy. Student's t-test was used for statistical evaluation. RESULTS: Most of the hysterectomised women had abnormal serum lipid profile, especially HDL cholesterol levels (less than 40 mg/dL in 87%). A significant decline in the levels of serum cholesterol (total) as well as LDL and a significant increase in HDL cholesterol levels were observed following ORT by both modes, the response being comparatively rapid with oral route. After 3 and 6 months, the number of cases with HDL cholesterol levels above 40 mg/dL increased from initial 13 to 63% and 87% (oral) and 30 and 60% (transdermal), respectively. Serum triglyceride levels declined significantly with transdermal therapy but increased with oral ORT. CONCLUSIONS: Oestrogen replacement therapy either via oral or transdermal route has a beneficial effect on serum lipid profile of menopausal women. Whereas the oral route is more effective in increasing HDL cholesterol levels, the transdermal route is better for reducing the serum triglyceride level; hence, the latter should be the route of choice in women with high serum triglyceride levels.